Project Summary: Ocular telemedicine can deliver eye care to millions of Americans who do not have access to services. This K23 proposal demonstrates Dr. Maria A. Woodward's commitment to research that addresses a national and global public health care need and her commitment to the pursuit of investigator independence. Although posterior eye diseases cause the majority of visual impairment in the United States, the National Eye Institute's (NEI) strategic plan states that anterior eye diseases result in the majority of visits to eye care professionals nationally and cause blindness in millions globally. The NEI plan also emphasizes the significant need for research that can establish the safety, reliability and feasibility of telemedicine procedures through pilot studies and determine which ophthalmic applications are amenable to telemedicine, while still preserving the accuracy, sensitivity and specificity achieved with in-person examinations. Although funded research projects have established fundus photography for remote assessment of diabetic retinopathy, no pilot projects have focused on the external and anterior eye. Dr. Woodward's career public health goal is to extend affordable and accessible eye care to underserved communities in order to detect eye conditions earlier in their course. Her career research goal is to test applications of ophthalmic technology that are amenable to telemedicine. The immediate project goals are two-fold. First, the applicant seeks to develop rigorous and accurate methods for detecting key external and anterior eye diseases using external photography. The applicant will conduct pilot studies testing external photography protocols on subjects with known anterior eye diseases. Second, the applicant seeks to validate a vision questionnaire that will augment comprehensive telemedicine assessments to determine eye health and whether or not anterior eye diseases are present. The applicant will administer multiple pre-validated vision questionnaires (e.g., the National Eye Institute Visual Function Questionnaire) and correlate answers with clinical examination findings. Dr. Woodward's research is supported by training goals that will provide the foundation for her to develop into an independent investigator. The applicant will utilize the immense resources at the University of Michigan and the support of research mentors, including Drs. Paul Lee and David Musch, to accomplish three specific training aims: 1) expertise in research methodology, 2) excellence in telemedicine programmatic development, and 3) refined knowledge of ophthalmic imaging. Dr. Woodward has set forth a plan for targeted coursework, individualized mentorship, and directed self-study to assure achieving these aims. In the process, she will obtain a master's degree in health and health care research from the Robert Wood Johnson Foundation Clinical Scholars Program.